Performance of Imaging Modalities in the Diagnosis of Hepatocellular Carcinoma: a Systematic Review and Meta-Analysis

Abstract

Purpose: The recent guidelines published in 2011 suggest the use of only one imaging method for the final imaging diagnosis of hepatocellular carcinoma. To evaluate the methods in the context of the available literature evidence, this systematic review aimed at assessing the relative performance of different imaging techniques currently used in clinical practice.

Materials and Methods: MEDLINE and EMBASE were searched from January 1996 to June 2011, with no language limitation. Eligible trials had to be conducted in patients with suspicion or diagnosis of hepatocellular carcinoma; compare at least two of the following imaging modalities: magnetic resonance imaging, computed tomography, ultrasound; have pathological findings as a reference standard. An analysis also including non-comparative studies was performed as a validation of the main comparison results.

Results: Of 5,144 screened papers, 16 studies fulfilled the eligibility criteria for the comparative analysis and 65 were eligible for the non-comparative analysis. The overall sensitivity and specificity derived by the pooled analysis were 0.78 and 0.77 for computed tomography, 0.84 and 0.84 for magnetic resonance imaging and 0.86 and 0.77 for ultrasound, respectively. In the pair-wise comparisons, ultrasound showed a statistically better specificity than magnetic resonance imaging (0.86 vs. 0.78; p = 0.014) and a statistically better sensitivity than computed tomography (0.88 vs. 0.78; p = 0.030).

Conclusion: The present systematic review did not show an obvious superiority of one imaging method. Since their accuracy is not completely overlapping, the possibility of reaching better performance by combining methods should be considered in future prospective trials.

Zusammenfassung

Ziel: Die im Jahr 2011 veröffentlichten aktuellen Leitlinien empfehlen beim hepatozellulären Karzinom, nur ein bildgebendes Verfahren zur endgültigen bildgebenden Diagnostik einzusetzen. Das Ziel dieses systematischen Reviews war es, durch die Auswertung der evidenten, verfügbaren Literatur die relative Leistung von verschiedenen, in der klinischen Praxis verwendeten bildgebenden Techniken zu bewerten.

Material und Methoden: Von Januar 1996 bis Juni 2011 wurden MEDLINE und EMBASE ohne Spracheinschränkungen durchsucht. Geeignete Studien sollten bei Patienten mit Verdachtsdiagnose bzw. diagnostisch bestätigtem hepatozellulärem Karzinom durchgeführt worden sein, wobei mindestens zwei der folgenden bildgebenden Methoden verglichen wurden: Magnetresonanztomografie, Computertomografie, Ultrasonografie. Zusätzlich sollten pathologische Befunde als Referenzstandard vorhanden sein. Es wurde eine Analyse durchgeführt, die auch nicht vergleichende Studien einschloss, um die wichtigsten Vergleichsresultate zu bewerten.

Ergebnisse: Von 5144 durchgesehenen Publikationen erfüllten 16 Studien die Eignungskriterien der vergleichenden Analyse und 65 waren für eine nicht vergleichende Analyse geeignet. Die aus der gepoolten Analyse abgeleiteten Gesamt-Sensitivitäten betragen für die Computertomografie 0,78, für die Magnetresonanztomografie 0,84 und für die Ultrasonografie 0,86, die Gesamt-Spezifitäten betragen für die Computertomografie 0,77, für die Magnetresonanztomografie 0,84 und für die Ultrasonografie 0,77. Beim paarweisen Vergleich zeigte die Ultrasonografie eine statistisch höhere Spezifität als die Magnetresonanztomografie (0,86 vs. 0,78; p = 0,014) und eine statistisch höhere Sensitivität als die Computertomografie (0,88 vs. 0,78; p = 0,030).

Schlussfolgerung: Da die diagnostische Genauigkeit nicht vollständig übereinstimmt wäre in zukünftigen prospektiven Studien zu prüfen, ob sich durch eine geschickte Methodenkombination die Ergebnisse verbessern ließen.

Key words

systematic review - hepatocellular carcinoma - diagnostic tests

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